Provider Demographics
NPI:1386695328
Name:KHANDAT, AMARESH B (MD)
Entity type:Individual
Prefix:DR
First Name:AMARESH
Middle Name:B
Last Name:KHANDAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 BATTISTA CT
Mailing Address - Street 2:#303
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2545
Mailing Address - Country:US
Mailing Address - Phone:804-415-1156
Mailing Address - Fax:
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8002
Practice Address - Fax:804-863-1665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012373792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189404Medicaid
VA189408Medicaid
VAO88475MMedicaid
VA189398Medicaid
VAO88057MMedicaid
VA189401Medicaid
VA189406Medicaid
VA189407Medicaid
VA189399Medicaid
VA189402Medicaid
VA189401Medicaid
VAO88057MMedicaid